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Emergent Leadership for the Formal Leader


A lot of the traditional leadership literature contains information about “emergent leadership). Much of the notions of leadership involve use of position, power, control, direction, and authority. Leadership is often looked at as “being in charge” or “being the boss”. Yet, today, much is known about complex adaptive and responsive systems and life and experience within the midst of highly changing and greatly adapting systems structures. Emerging from the complexity sciences, the notion of emergence is associated with self-organizing complexity and the mechanisms of chaos within systems frames.

Hospitals and healthcare systems are complex and nonlinear structures and therefore it should not be surprising that they represent the many characteristics of chaos and complexity. These organizations, by virtue of their complexity, are full of emergent phenomena. Yet, all of these phenomena fly in the face of traditional linear, vertical, and hierarchical notions of order, control, direction, and decision-making. Emergent phenomena on the other hand, reflect the more spontaneous, uncontrolled realities operating at the boundaries of the external and internal elements of the system, creating the conditions which challenge and change everything in a spontaneous and often unanticipated way.

This notion of the emergent within the context of leadership has only recently been given more emphasis in the understanding and teaching of leadership concepts. It is the obligation of the contemporary leader to understand the nature of complexity and to develop and respond in his or her leadership role in a way that reflects accommodation and incorporation of emergent realities. In hospitals, of course, this will be especially difficult since the traditional and very powerful medical hierarchy has operated for generations and, even today, holds sway over much of the construct and structure of organizations. Yet, there is increasing evidence that such structures not only fail to work in the understanding of complexity systems, but actually act as an impediment to effectiveness. Much of what we know regarding patient process, safety, quality, and outcome reflected the structural inadequacies embedded in formal, linear, vertical, and hierarchical configurations. Within the context of complexity, the breadth and depth of information, knowledge, and applications essential to make patient care successful now reflect the complete dependence on a wide variety of professionals with unique skill-sets that reflect the depth and breadth of knowledge and application that no single entity can comprehend, control, or apply. In complex responsive systems, therefore, it is critical that the multifocal, and multilateral access to knowledge and skills form the foundation for clinical decision-making and application and operate free of a unilateral locus-of-control.

The traditional command and control medical model parallels this reality in most organizations and, in an evidence-based-framework, cripples broad-based good judgment and immediate responsive action. Understanding the intersection and interface of competence, roles, and practices within the framework of complex responsive processes becomes an important element of successful action in complex organizations. It is here where the formal leader, understanding issues of emergence and complexity, can create an environment of integrity, partnership, engagement, and true team operation. The formal leader recognizes the value of emergent leadership; that leadership which emerge as a result of conditions, circumstances, or situation. In a clinical situation where a particular skill set is required to make clinical judgment, that individual, in the moment, emerges into the leadership role, applying knowledge and skills in a way that makes an immediate difference. Recognizing this emergent leader, driven by situation and demand, calls the formal leader to reflect both the understanding and tools necessary to better and more immediately respond to the needs of the particular situation and event. The formal leader, in a way which ensures the potential and appropriate use of the emergent leader, creates the context and conditions as well as successful processes that allows such emergent leadership to be a part of direction, decision-making, and action-taking.

Creating the conditions that allows systems and people to adapt to anticipation, expectation, and use of the emergent leader is now a critical element of the function of formal leadership. In creating necessary supporting conditions, the formal leader ensures:

ü  there is an understanding of the value and role of emergence in decision-making and action in a clinical environment,

ü  there is a management process within which emergent leadership can operate and reflect the competencies and skills needed and expressed at particular moments in decision-making and action-taking,

ü  team-based approaches to planning, problem solving and solution-seeking represents the engagement and valuing of the contribution of all stakeholders to any given process or situation requiring their skills,

ü  the formal leader values, exemplifies, and expresses equity in roles and relationship, recognizing the value of each member of the clinical team and the unique contribution each makes in the complex array of plans, decisions, and actions related to the effective delivery of patient care,

ü  patients are included in the team partnership and opportunities for emergent leadership in making decisions about care, clinical choices, and values from the perspective of the patient as primary “user”,

ü  emergence in a complex system reflects a continuous dynamic of development and understanding associated with awareness of and availability to the high-level patterns of structure, order, characteristics, and interactions along with a deeper understanding of their intersection with operations, decisions, relationships, roles, and clinical actions,

ü  engagement is a fundamental characteristic of complex responsive systems, with the expectation that leaders comprehend and apply principles of partnership, accountability, and collective wisdom, along with shared insights and roles,

ü  in emergent leadership the notion of communities of action or practice is a critical centerpiece influencing the realities of mutuality, membership, obligation, partnership, and individual and collective ownership of the processes, decisions, and actions of the group.

This discussion of these elements form some of the foundations of the contemporary formal leader’s thinking, role, and expression of leadership. The challenge here, for the formal leader, is to deepen and broaden understanding of the emergent characteristics of complex responsive processes and systems. This leader recognizes the need for the application of these new levels of understanding regarding leadership within the context of his or her personal role and in the framework or context which provides the demand for accommodating these realities within the clinical work system. As we continue to refine and deepen our discussions of leadership here, understanding will build progressively within concepts grounded in complex adaptive systems and in subsequent research which expands our understanding of leadership effectiveness and continuously dynamic and changing systems. It is our hope that you will respond and contribute to the growing understanding of leadership in complexity and in deepening our knowledge and skills related to it.  Dr. Tim

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